When a dying patient is asked to participate in a double-blind, placebo-controlled clinical trial on symptom control: The decision-making process and experiences of relatives

Harriëtte J. van Esch*, Arianne Stoppelenburg, Lia van Zuylen, Carin Cd van der Rijt, Agnes van der Heide

*Corresponding author for this work

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BACKGROUND: Placebo-controlled trials can provide evidence to inform end-of-life care, but it is contested whether asking dying patients to participate in such trials is morally justifiable. To investigate the experiences of these patients is even more complex. Therefore, proxy assessments by relatives can be a good alternative. AIM: To explore the experience of participating in a placebo-controlled trial at the end of life from the perspective of bereaved relatives. DESIGN: Mixed-method study, including questionnaires and interviews. SETTING/PARTICIPANTS: The SILENCE study was a randomized, double-blind, placebo-controlled trial on the efficacy of scopolamine butylbromide to prevent death rattle. The study was performed in six inpatient hospice facilities. Patients were asked to participate at admission in the hospice. Three months after the death of the patient, bereaved relatives were invited to fill in a questionnaire and to participate in an interview. One hundred four questionnaires were completed and 17 relatives were interviewed. RESULTS: Fourteen percent of the relatives participating in the questionnaire study considered the participation of their loved one in research a bit burdensome and 10% considered it a bit stressful. Seventeen percent thought that it was a bit burdensome for the patient. Eighty-three percent considered participation in this type of research (very) valuable. The in-depth interviews showed that patients and relatives jointly decided about participation in this double-blind placebo-controlled medication trial. Relatives generally respected and felt proud about patients' decision to participate. CONCLUSION: The large majority of bereaved relatives experienced the participation of their dying love one in this RCT as acceptable and valuable.

Original languageEnglish
Pages (from-to)1552-1558
Number of pages7
JournalPalliative Medicine
Issue number10
Publication statusE-pub ahead of print - 12 Dec 2022

Bibliographical note

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by the palliative care research program “Palliantie” of The Netherlands Organization for Health Research and Development (grant number 844001203). HVE reports additional funding from “Laurens Zorg in Balans.” CR reports additional funding from “Stichting Voorzieningenfonds Calando.” All sponsors had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; nor the decision to submit the manuscript for publication.


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